Ford PAS Site Visit Pre-Assessment Form

School Information

Name of School:

Building IRN:

School District:

District IRN:

Administrative Contact:

Name:

Phone Number(s):

Email:

Are you currently receiving career technical weighted funding for Ford PAS? Yes No

What EMIS code are you using to report this course to ODE?

Is this currently a Tech Prep program? Yes No

If yes, which consortium are you affiliated with?

Year your school started with Ford PAS:

In what grades are you implementing Ford PAS activities: 9th 10th 11th 12th

Have your teachers registered on the Ford PAS web site? Yes No

Have your students registered on the Ford PAS Website?

All students are registered. The number registered is:

Some students are registered the number registered is: out of total

None registered

Teacher Information

FORD PASS Teachers Name	FORD PAS Modules they are trainedto teach	Location(s) and year(s) of training	Ongoing Professional Development
			Yes No
			Yes No
			Yes No
			Yes No
			Yes No

Curriculum Information

Which Modules are being taught as complete modules?

1	6	11
2	7	12
3	8	13
4	9	14
5	10	15

Which Modules are you using parts of?

1	6	11
2	7	12
3	8	13
4	9	14
5	10	15

Are you using Ford PAS modules or activities in any academic courses? Yes No

If “yes”, please list the courses:

Counselor Information

Counselor(s) Name	Type of Ford PAS familiarization and training received?	Location(s) and year(s) of training

Enrollment Information (current year)

Module #	Course Name	Enrollment Total	Total females enrolled	Total males enrolled

Business/Education Advisory Council Information

Member Name	Title/Role	Business Name	Contact Information

Technology for School/Program/Class site

How many computer labs are available for the program/class?

How many students per computer?

How reliable is the internet access at the school site?
Scale: 1= Not Reliable, 5= Very reliable

Teacher proficiency in the use of computers on average?
Scale: 1= Not skillful, 5=Highly proficient

Teacher Experience

Please provide a narrative with specific information addressing the following areas:

What worked well? What challenges did you encounter?
Did you use the available technology during the teaching of modules (web site resources/software, etc.)?
Did you make any modifications/adaptations to the modules or any changes to your original implementation plan?
Did you implement any of the Coordinated Learning Experiences (CLEs)? How did they connect to the module content?

Please provide a narrative of program highlights, including achievements made, challenges encountered, changes in original plans, and any other relevant information you wish to provide.